Radiology’s Role in Lung Cancer Screening Programs

With reimbursement for low-dose CT lung cancer screening assured, radiology will be called on to play an important role in the development and operation of screening programs.

When it comes to lung cancer, the numbers tell a grim tale.

It is the second most common cancer in both men (behind prostate cancer) and women (behind breast cancer) and accounts for about 13% of all new cancers.

Even more discouraging is the fact that lung cancer is decidedly lethal. According to the American Cancer Society, lung cancer accounts for about 27% of all cancer deaths making it by far the leading cause of cancer death among both men and women.

It’s a “silent killer” pointed out William Way, MD, chief medical officer of Wake Radiology, a practice with more than 50 radiologists in 20 locations in the Raleigh, N.C., area. “It’s an aggressive malignancy that presents late after it has metastasized, so early detection is a huge advantage.”

Which is precisely why many radiologists have become strong advocates of low-dose CT (LDCT) lung cancer screening and its potential for significantly reducing lung cancer mortality.

One of the largest clinical CT lung screening programs in the country has been implemented by Lahey Hospital & Medical Center in Burlington, Mass. For Lahey, says Brady McKee, MD, a radiologist at Lahey and co-founder of the hospital’s “Rescue Lung, Rescue Life” CT lung screening program, the tipping point for CT lung screening came when the National Lung Screening Trial (NLST) was halted in 2010. That trial was stopped after early results showed that screening heavy smokers with LDCT reduced lung cancer deaths by 20% compared to screening with chest x-ray.

“We really took notice of that result, and we started to think about having a program at Lahey and how that would take shape,” McKee says.

According to McKee, while Lahey’s radiology department and Cancer Center were the primary drivers behind the program, it became a multidisciplinary effort. “And that’s probably why were able to be successful,” he adds. “We really didn’t try to drive it out of radiology, because we knew there were lots of other people who had to be involved.”

Rallying call

As at Lahey, the NLST was the event that truly galvanized thinking about the possibility of a CT lung screening program at OhioHealth, a network of 11 hospitals, 50-plus ambulatory sites, hospice, home-health, medical equipment and other health services spanning 40 counties in Ohio.

“Now, for the first time, we had a major study that actually showed there was an ability to reduce mortality when you screened at-risk patients,” says Tom Buse, MD, medical director of radiology, Riverside Methodist Hospital in Columbus.

There was some initial hesitation, however, particularly since the United States Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) had yet to weigh in on the subject. “We didn’t know whether anyone would even order the exam since no insurance company was going to pay for it and Medicare wouldn’t cover it,” Buse adds. “A lot of these high-risk patients can’t afford CT imaging, so what good would a [LDCT screening program] do?”

Since there was no reimbursement available for screening, “we didn’t want to launch our program too soon and have no patients come,” Buse continues, but OhioHealth was still being proactive. “We formed a small steering committee at Riverside Methodist—our flagship hospital—because we wanted to be ready when the results came out,” Buse said. “When those results came out, we increased the urgency to get a program together.”

Taking the first step

The initial step was to set up a multidisciplinary task force on CT lung cancer screening that included radiologists, thoracic surgeons, pulmonologists, oncologists and radiation oncologists. According to Buffy Jansak, system program director for lung and prostate cancer for OhioHealth Cancer Services in Dublin, Ohio, this multidisciplinary approach involved interaction with dozens of departments within OhioHealth.

“I think I counted more than 65 different departments I had to work with, such as our legal, revenue cycle, patient access service, and billing departments,” she said. “So there were a lot of other meetings going on outside of that [task force] that had to occur to make sure we had our ducks in a row.”

The program was launched at three OhioHealth sites on July 22, 2013, (a week before the USPSTF issued its decision recommending LDCT screening) using